Recent scientific studies confirm the presence of torture and multiple traumatic events in the life history of refugees. Studies of diverse refugee populations indicate high prevalence rates of psychiatric disorder including posttraumatic stress disorder (PTSD) and major depression. As a result there has been a growing trend to address the mental health needs of these individuals. Yet there are barriers to refugees asking for and receiving appropriate mental health services. These barriers include language, culture proscriptions against the use of mental health services, financial considerations, and the practical demands of resettlement and employment. The present proposal is to establish and evaluate a different approach to the problem of mental health service delivery to the refugee population in Boston. We suggest that integration of mental health services directly into the resettlement process will remove some of the barriers to receiving care. As such, we will compare to each other two large groups of participants receiving related but different treatment approaches; both active treatments will be also compared to a smaller """"""""Care as Usual"""""""" group. The first of the active treatments is Cognitive Processing Therapy (CPT), suitably modified for use with the Bosnian refugee population and presented in two four hour workshops early in the resettlement period; the second treatment includes CPT combined with a commonly used public health intervention, home visits. These home visits will be structured learning opportunities that will provide specific learning experiences in problem solving and will review the didactic materials learned in the workshop. We will be able to randomly assign a total of sixty participants to the Care as Usual group in order to answer some basic questions about the usual response to the resettlement process. Evaluations of the larger cohort of participants will be conducted at pretreatment, posttreatment, 6 months and 12 months. Variable domains will include psychological symptoms, psychosocial functioning, and health care utilization. Measures of social cognition regarding belief systems and perceived dangerousness will be included as predictors of change and adjustment. Data analyses will employ growth curve analytic approaches and will compare the relative effectiveness of the three interventions for torture survivors with and without PTSD and/or major depression and non-tortured refugees with and without PTSD.
